Original Articles By Dr. Lavin Featuring Expert Advice & Information about Pediatric Health Issues that you Care the Most About

The Summer Bug- Hand-Foot-Mouth, Sleepy Fever, Stomach Flu- All from the Enterovirus

We are all familiar with the influenza or flu epidemic that happens every winter, but many of us are not so familiar with a virus that causes a tremendous number of fevers and infections every summer, the enterovirus.

What is an Enterovirus and What Illnesses Do they Cause?

Entero- means intestinal in Greek and so enterovirus means, virus of the intestine, and it frequently is.

The enteroviruses cause many epidemics typically only seen in the summer through early fall- June to October- with major flares in July and August.

We are right now (July 17, 2014), experiencing a major outburst of enterovirus infections in our community.

The enteroviruses can cause a very wide range of infections, but the most common are the following:

  1. Stomach flu- fever, vomiting, and diarrhea
  2. Hand-foot-mouth disease- small very uncomfortable red, small-fluid filled bumps on the palms and soles and many tiny cold-sore like lesions in the mouth, usually with fever.
  3. Viremia- just fever, no other symptoms except at times a rash at the end of the fever
  4. Colds and pink eye- runny nose, cough, fever, red eyes with or without discharge
  5. Mild CNS [central nervous system] infections- these can cause pronounced tiredness or even sleepiness, fever, at times with severe headache and even stiff neck.   They are mild because complete recovery is the rule.

If you look up Enteroviruses, you will find they come in various families of viruses.  The two main categories of Enteroviruses are the Coxsackie and ECHO viruses.  Coxsackie viruses are named after a town in New Jersey, Coxsackie, where the first strains were found.   ECHO comes from an outdated acronym that implies this is a virus found in the stools of children with no illness, but we now know that the ECHO viruses can cause the enteroviral illnesses.

There is one, perhaps most famous enterovirus, that no longer causes infections in the United States, the polio virus.  It turns out that when polio was rampant, most people who got this enterovirus got a stomach flu, like other enteroviral infections.  But occasionally this virus would also cause a CNS infection, but in the case of polio virus, the infection of the central nervous system is far more severe and actually does cause damage, the dangerous infection of polio.

How do they Spread, Incubation Periods, How Long are You Contagious?

Interestingly, one enterovirus can cause several of these infections, so you could catch an enterovirus from someone with hand-foot-mouth disease and experience a viremia.

With the exception of colds, most enteroviral infections are spread not by breath but by hand contact.  Handwashing should block contagion.

If you are exposed to a person with an enteroviral infection, and catch the illness, it typically takes 3-6 days to develop symptoms, so the incubation period is 3-6 days.

Children and adults with enteroviral infections are contagious, otherwise they wouldn’t have caught the illness.

Someone remains contagious as long as their body sheds live virus.  This typically goes on for some time after fully recovering, which explains why the period for being contagious can seem surprisingly quite long.

For those with mainly respiratory infections like colds and pink eyes, they remain contagious for 1-3 weeks.  But for those with stomach flu, one can remain contagious for months.

Right now we are seeing a very large number of cases of hand-foot-mouth diseases, viremias, and mild CNS infections, as well as some stomach flu, all likely due to the enteroviruses.

What to Do

When it comes to what to do if your child gets infected with an enterovirus, there are several key points:

  • Like nearly all viral infections, medical science has not yet developed any medication to rid us of the infection, so antibiotics do nothing to help a person with enteroviral infections
  • These infections, as uncomfortable as they are, are typically harmless.  Given that we cannot cure them, our job is to make our children comfortable.  Comfort varies according to the problem.  For viremias where the only symptom is fever, ibuprofen is often sufficient.  For the painful sores of hand-foot-mouth there are a variety of soothing measures for the sore throat- cold liquids, ice cream, comfort foods, etc.
  • All these infections go away in a few days to a week or two and typically leave your child as healthy as before the illness.
  • As for contagion, we all spread virus long after we get well, especially for stomach flu where you can remain contagious for months.  Further, these viruses are rampant now, so even if you isolated your child completely while she or he is contagious, the viruses would spread exactly to the same extent.  So we do not recommend isolation for contagiousness.



This summer is no exception, we are experiencing our annual summer epidemics of enterovirus infection right now.

  • These viruses cause a wide range of illnesses, nearly all of which are quite harmless.   The one variant that is harmful is the one we immunize against and no longer is in North America.
  • There are no medications to get rid of these viruses, to care is limited to keeping your child comfy.
  • The most common forms of infection with the enteroviruses are hand-foot-mouth disease, stomach flus, simple fevers with and without rash, and fever and severe lethargy with and without headache.
  • No need to isolate, once your child feels better, back in action.


Here is to a safe and healthy summer,
Dr. Arthur Lavin

One Response to The Summer Bug- Hand-Foot-Mouth, Sleepy Fever, Stomach Flu- All from the Enterovirus

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